Khezerlouy-Aghdam Naser, Toufan Tabrizi Mehrnoush, Seyed Toutounchi Kia, Jabbaripour Sarmadian Amirreza, Masoumi Shahab
Cardiovascular Research Center Tabriz University of Medical Sciences Tabriz Iran.
Faculty of Medicine Tabriz University of Medical Sciences Tabriz Iran.
Clin Case Rep. 2024 Mar 7;12(3):e8597. doi: 10.1002/ccr3.8597. eCollection 2024 Mar.
Before valvular interventions, echocardiography, especially the TEE or the ventilation/perfusion scan, should be performed to detect silent PTE and set a more accurate treatment and surgical plan.
Pulmonary hypertension (PH) is a progressive and critical disease that can be caused by mitral stenosis (MS). Some of these patients present with disproportionate PH, which is an uncommon phenomenon and is considered a challenging diagnostic and treatment process. In these patients, other causes may also play a role in developing PH. This report presented two cases with disproportionate PH and severe MS who were scheduled for percutaneous mitral valvuloplasty (PMV). The pre-procedural echocardiography revealed systolic pulmonary artery pressure (sPAP) of 90 and 120 mmHg, mitral valve area of 0.80 and 0.55 cm by three-dimensional (3D) planimetry, and diastolic pressure gradient (DPG) of 13 and 18.8 mmHg, respectively. Furthermore, in the first patient, 3D transesophageal echocardiography (TEE) revealed multiple saddle-type organized thrombi in the proximal parts of the right and left pulmonary arteries, extending to the distal branches. In the second patient, 3D TEE revealed a large, relatively fresh, flow-limiting thrombosis in the proximal part of the right pulmonary artery. The diagnosis of pulmonary thromboembolism (PTE) in both patients was confirmed by CT angiography. In both patients, the valves were surgically repaired, while all thrombi were removed from the cardiac chambers and pulmonary vessels during surgery. In addition, patients underwent warfarin therapy orally. They were followed up 6 months after the intervention, and their clinical symptoms had improved significantly.
在进行瓣膜干预之前，应进行超声心动图检查，尤其是经食管超声心动图（TEE）或通气/灌注扫描，以检测无症状肺栓塞并制定更准确的治疗和手术方案。
肺动脉高压（PH）是一种进行性的严重疾病，可由二尖瓣狭窄（MS）引起。其中一些患者表现为不成比例的PH，这是一种罕见现象，被认为是一个具有挑战性的诊断和治疗过程。在这些患者中，其他原因也可能在PH的发生中起作用。本报告介绍了两例计划进行经皮二尖瓣球囊成形术（PMV）的不成比例PH和严重MS患者。术前超声心动图显示收缩期肺动脉压（sPAP）分别为90和120mmHg，二尖瓣面积通过三维（3D）平面测量法分别为0.80和0.55cm²，舒张期压力阶差（DPG）分别为13和18.8mmHg。此外，在第一例患者中，三维经食管超声心动图（TEE）显示左右肺动脉近端有多个鞍型机化血栓，延伸至远端分支。在第二例患者中，三维TEE显示右肺动脉近端有一个大的、相对新鲜的、限流性血栓。两例患者的肺血栓栓塞症（PTE）诊断均经CT血管造影证实。两例患者均接受了瓣膜手术修复，同时在手术中从心腔和肺血管中清除了所有血栓。此外，患者口服华法林治疗。干预后对他们进行了6个月的随访，其临床症状有明显改善。
